Translating cancer immunology into novel therapies against aggressive brain tumors.

Ventricular entry (VE) during resection can maximize high-grade glioma (HGG) resection, but it remains unclear whether tumor contiguity to the ventricles or VE increases the risk of leptomeningeal metastasis (LM) and/or worsens overall survival (OS). To clarify the role of VE and tumor location in LM incidence and OS, the authors retrospectively reviewed the charts of patients who underwent their first resection of supratentorial HGG at The University of Texas MD Anderson Cancer Center between 1993 and 2021. The authors identified 884 patients: 390 (44%) had VE and 444 (50%) had ependymal contact (EC) tumors. On multivariate analysis, VE did not significantly predict LM or OS. However, EC significantly increased LM risk and worsened OS. Tumors with EC predict higher LM risk and shorter OS, while VE during resection does not increase LM risk or worsen OS. Surgeons can use VE to maximize resection of supratentorial HGGs without increasing the risk of subsequent LM.